May Measurement Month: beyond boosting hypertension awareness
Authors: Nana Pogosova
Journal: The Lancet Global Health (2022)

Since the launch of May Measurement Month (MMM) in 2017, this joint initiative by the International Society of Hypertension and the World Hypertension League has emerged as an important source of blood-pressure-related information both nationally and globally. The primary aim of MMM is simply to raise awareness of blood pressure measurement and hypertension, which is of paramount importance given the high proportion of people with hypertension who are either unaware that they have the condition, or are aware of their condition but do not have it under adequate control. However, despite the simplicity of the campaign design, it allows for the creation of a very large database that contains blood pressure data from millions of participants. MMM implements procedures that assure the robustness of blood pressure data, such as the use of approved devices and trained volunteers to take readings. Three seated blood pressure readings are taken at 1-min intervals, which is consistent with current guidelines. The MMM participants also provide data on their demographics, lifestyle risk factors, history of cardiovascular diseases or diabetes, and anthropometric parameters. Considering the scale and robustness of the data, the increasing use of MMM-derived data to make assessments of the prevalence and control of hypertension and associated risk factors is unsurprising. To date, studies have assessed national-level MMM data from Nepal,1Bhattarai H McLachlan CS Khanal P et al.May Measurement Month 2019: an analysis of blood pressure screening results from Nepal.Eur Heart J Suppl. 2021; 23: 110-113Crossref Scopus (2) Google Scholar Colombia,2Lopez-Jaramillo P Lopez-Lopez JP Otero J et al.May Measurement Month 2019: an analysis of blood pressure screening results from Colombia.Eur Heart J Suppl. 2021; 23: 46-48Crossref Scopus (1) Google Scholar Greece,3Stergiou GS Menti A Doumas M et al.Opportunistic screening for hypertension in the general population in Greece: International Society of Hypertension May Measurement Month 2019.Eur Heart J Suppl. 2021; 23: 66-69Crossref Scopus (1) Google Scholar and Hong Kong,4Li JTS Lam ASM Tomlinson B et al.May Measurement Month 2017–2019: a community-wide opportunistic blood pressure screening campaign in Hong Kong.Int J Hypertens. 2021; 20218891794Crossref Scopus (1) Google Scholar in addition to global-level data.5Poulter NR Borghi C Damasceno A et al.May Measurement Month 2019: results of blood pressure screening from 47 countries.Eur Heart J Suppl. 2021; 23: 1-5Crossref Scopus (6) Google Scholar However, MMM implements an opportunistic screening strategy, and questions arise regarding the validity of the findings and their applicability to the general population. For example, a 2021 study6Andersson H Hedström L Bergh H White-coat hypertension detected during opportunistic blood pressure screening in a dental healthcare setting.Scand J Prim Health Care. 2021; 39: 348-354Crossref PubMed Scopus (2) Google Scholar of opportunistic blood pressure screening in healthy adults showed that 57·2% of participants with clinically elevated blood pressure actually had white-coat hypertension. However, the high proportion of white-coat hypertension in this study might be partly explained by the stressful screening settings, as blood pressure readings were taken during annual dental examinations. In any case, according to a 2020 Cochrane review, the most advantageous screening strategy for hypertension is yet to be established.7Schmidt B-M Durao S Toews I et al.Screening strategies for hypertension.Cochrane Database Syst Rev. 2020; 5CD013212PubMed Google Scholar Studies that link opportunistic screening results to data obtained through other strategies therefore seem highly relevant. A study in Greece8Menti A Kalpourtzi N Gavana M et al.Opportunistic screening for hypertension: what does it say about the true epidemiology?.J Hum Hypertens. 2022; 36: 364-369Crossref PubMed Scopus (1) Google Scholar compared results from MMM 2019 and the National Survey of Morbidity and Risk Factors (EMENO; 2013–2016), which applied a multistage, stratified, random-sampling method to collect nationwide data. Together, the surveys included a total of 10 426 adults (EMENO 4699; MMM 5727). Whereas the prevalence of hypertension in EMENO (39·6%) and MMM (41·6%) participants was similar, the opportunistic screening strategy underestimated the prevalence of undiagnosed hypertension and overestimated the prevalence of hypertension treatment and control. Despite the cautious conclusion that screening programmes such as MMM are primarily useful for raising awareness of hypertension and that national random sampling studies are needed to assess its epidemiology, these data provide hope for the usefulness of opportunistic screening, at least in the absence of high-quality data. From this point of view, a new analysis of MMM data focusing on stroke history seems of great importance. Queran Lin and colleagues9Lin Q Ye T Ye P et al.Hypertension in stroke survivors and associations with national premature stroke mortality: data on 2·5 million participants from multinational screening campaigns.Lancet Glob Health. 2022; 10: e1141-e1149Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar examined the 2017 and 2018 MMM data covering more than 2·5 million participants from 92 countries, focusing not only on blood pressure readings but also on stroke history and on blood pressure control and risk factors in stroke survivors. Nearly 90% of participants had recorded data on stroke history, and almost 63 000 participants reported a previous stroke. Participants with a history of stroke were older and more likely than those with no history of stroke to report comorbidities (such as diabetes or previous myocardial infarction), smoking, regular alcohol consumption, and body-mass index outside of the healthy range. The age-standardised and sex-standardised rates of hypertension, antihypertensive treatment, and blood pressure control were all higher in participants with a history of stroke than in those without. But perhaps the most important part of this analysis was linking the national mean blood pressure data and parameters of hypertension management with national estimates of premature stroke mortality based on Global Burden of Disease (GBD) data. Despite the limitations of the opportunistic approach and the imbalance in the screening settings (48·5% of participants were screened in health-care facilities, 39·5% in public places, and 10·1% in workplaces), several highly significant associations were found between the MMM and GBD data. Considering that many countries involved with the MMM campaigns do not have available systematic screening data, MMM should be considered as an important source of contemporary blood pressure data, both for policy makers and for research purposes. I declare no competing interests. Hypertension in stroke survivors and associations with national premature stroke mortality: data for 2·5 million participants from multinational screening campaignsBlood pressure control remains suboptimal worldwide among people with a history of stroke. National estimates of blood pressure management reflect national premature stroke mortality sufficiently to prompt policy makers to promote blood pressure screening and management. Full-Text PDF Open Access